Orchestrating interoperability: One size does not fit all

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 - Paul Chang, MD
Paul Chang, MD, University of Chicago Medical School

Paul J. Chang, MD, loves live jazz, hates the ballet—and extends his taste to two different means of wringing useful business intelligence from medical imaging informatics.

“If I go to the ballet three days in a row, I will see the same performance every day. It’s an example of choreography,” explains the vice chair of radiology informatics at the University of Chicago. “The dancers respond to a certain broadcast signal, just like an HL-7 or DICOM message—the beat of a drum, the change of a key—and they jump in the air knowing that someone will catch them. Every single time.”

He’ll pick a jazz concert over the ballet every time, he said during a presentation at RSNA last November, because the jazz will give him a different experience every time even when the same songs are played. That’s because a jazz concert is not choreographed but, rather, orchestrated.

“When you look at other business verticals”—that is, those outside healthcare—you see that, “without exception, they’ve gone beyond the primordial ooze of hardwired choreography to orchestration,” he said. “And by committing intellectual arbitrage, applying orchestrations that have been proven in other industries and applying them here, we can take advantage of a great risk-mitigation opportunity.”

Chang, who cited Amazon as his primary example of a master orchestrator—“I guarantee you my Amazon landing page looks very different from yours, because I buy different things from Amazon than you do”—presented “Interoperability and Integration—From HL7, DICOM and IHE to SOA,” on December 1, at the 2014 meeting of the Radiological Society of North America in Chicago.

“This is an opportunity for us to understand that we should be a little less arrogant about what we do with health IT,” he said. “We have to understand that we’re actually years behind other industries.”

Chang described how service-oriented architecture (SOA), and homegrown alternatives to it, can help radiology practices orchestrate integration and interoperability among and between disparate information systems—including those that don’t natively “dance with” each other.

Loose coupling, tight connections

The end game of all the computing, said Chang, is supporting imaging-informatics workflow to provide better, safer patient care at lower cost.

There’s actually nothing new about the concept behind SOA, said Chang, adding that early iterations were referred to as, for example, end-tier architecture or middleware. He likened the process to the human anatomy. “The concept is, instead of every cell broadcasting to every other cell, you have pipes that consolidate or aggregate information to a central bus or spinal cord,” he said. “Eventually, over time, that spinal cord develops a ‘brain.’ We call that business intelligence analytics.”

Enter orchestration. Instead of using only one way to consume information in the EMR—through the EMR client—information is extracted from sources throughout the enterprise. “We can make all of that usable and repurposable so that we can mash up an appropriately localized, idiosyncratically relevant experience,” Chang said. “That’s how our brain works. That’s how our spinal cord works. That’s how SOA works.”

Here Chang stated that healthcare is rife with major misconceptions about SOA. “When I go around the world and talk to CIOs, a lot of them say, ‘Oh yes, we have SOA.’ And they don’t. What they have are a whole bunch of web services.”

He said that, unlike web services, SOA is component-based architecture that supports composite applications—mashups—that are created by orchestration of loosely coupled services that are universally exposable, self-improvising and consumable. SOA, he added, requires disciplined governance, security, semantics, quality and service.

By contrast, “web services is the flavor of the month,” said Chang. “It’s an implementation technology.” You can do SOA using various transfer protocols, he said. “It doesn’t matter how you do it. The key point is loose coupling.”

‘Let the kids play’

One advantage of loose coupling in radiology is that end users can enter and access data without damaging data integrity, making the process attractive from a security point of view, said Chang.

“I can let the kids play, build whatever they want, without fear that they’ll screw something up,” he said. “That’s very different from today. Today when I want my EMR to just move something just over to the right, there’s a potential of breaking the system or the database. Why?